Myopia Control: Are We Ready for an Evidence Based Approach?

Abstract

Introduction: Myopia and its vision-threatening complications present a significant public health problem. This review aims to provide an updated overview of the multitude of known and emerging interventions to control myopia, including their potential effect, safety, and costs.

Methods: A systematic literature search of three databases was conducted. Interventions were grouped into four categories: environmental/behavioral (outdoor time, near work), pharmacological (e.g., atropine), optical interventions (spectacles and contact lenses), and novel approaches such as red-light (RLRL) therapies. Review articles and original articles on randomized controlled trials (RCT) were selected.

Results: From the initial 3224 retrieved records, 18 reviews and 41 original articles reporting results from RCTs were included. While there is more evidence supporting the efficacy of low-dose atropine and certain myopia-controlling contact lenses in slowing myopia progression, the evidence about the efficacy of the newer interventions, such as spectacle lenses (e.g., defocus incorporated multiple segments and highly aspheric lenslets) is more limited. Behavioral interventions, i.e., increased outdoor time, seem effective for preventing the onset of myopia if implemented successfully in schools and homes. While environmental interventions and spectacles are regarded as generally safe, pharmacological interventions, contact lenses, and RLRL may be associated with adverse effects. All interventions, except for behavioral change, are tied to moderate to high expenditures.

Conclusion: Our review suggests that myopia control interventions are recommended and prescribed on the basis of accessibility and clinical practice patterns, which vary widely around the world. Clinical trials indicate short- to medium-term efficacy in reducing myopia progression for various interventions, but none have demonstrated long-term effectiveness in preventing high myopia and potential complications in adulthood. There is an unmet need for a unified consensus for strategies that balance risk and effectiveness for these methods for personalized myopia management.

Keywords: Cost; Effect; Intervention; Myopia control; Myopia management; RCTs; Safety.

Fig. 1

Flowchart describing the process of literature search, identification, and selection

Fig. 2

Qualitative visualization of main myopia control methods in the East Asian ethnic group. Each intervention category is marked in a different color: outdoor time in green; atropine eye drops in blue; all types of myopia control spectacles are summarized in yellow; OK and myopia control SCL in violet; and RLRL in red. The bar heights and areas represent approximations; they are not proportional and cannot be taken as precise measurements. The amount of existing evidence was approximated from the number of identified RCTs (Fig. 1). The information summarized in the panels on effect, safety, and costs is extracted from the included RCTs (n = 41) and reviews (Supplementary Table 8). Since most of the available literature originates from East Asia, the visualization is limited to the situation in East Asian ethnicity. The color of the areas fades or question marks are places where there is uncertainty.